VENTILATORY SUPPORT STRATEGIES FOR DIFFERENT CAUSES OF RESPIRATORY FAILURE Flashcards
It occurs when
the respiratory system cannot maintain adequate gas exchange, leading to insufficient oxygen levels in the blood or elevated carbon dioxide levels, or both.
Respiratory Failure
2 Main Goals of Ventilatory Support
- Restore Adequate Gas Exchange
- Reduce Work f Breathing
Restoring Adequate Gas Exchange:
- Achieving sufficient oxygenation
(PaO₂ of ______ or SpO₂ of _____)
to prevent hypoxic injury. - Reducing _____________________ in hypercapnic failure.
- Pa02 of > 60 mmHg
Sp02 of > 90% - Reduce PaC02 to normal or target range.
What main goal of Ventilatory Support is this ?
- It assist or replace the effort of breathing
to prevent respiratory muscle fatigue. - Supports weakened or compromised respiratory
muscles, especially in neuromuscular conditions.
Reduce work of breathing
- Failure due to insufficient oxygenation despite normal ventilation
- also called Hypoxemia
Type 1 RF
It often results from V/Q mismatch or diffusion defects.
Type 1 RF
Widespread inflammation
= increase permeability of A/C membrane.
= increase accumulation of fluid in the alveoli.
= minimize/decrease the space/surface area which we use for gas exchange.
= HYPOXEMIA
ARDS
__Infection in the lungs__
= Alveolar consolidation
filling of alveoli with different substances s/a: Fluid, Puss, Blood
= Parts of the lungs that are consolidated can’t participate in gas exchange. (V/Q mismatch)
Pneumonia
__Blood Clot__
originates from Deep Vein Thrombosis
Block pulmonary arteries
= Blockage
= V/Q mismatch
Enough ventilation but not enough perfusion.
Pulmonary Embolism
Accumulation of fluid in the alveoli & interstitial space
Pulmonary Edema
TARGET:
Maintain oxygenation while minimizing ventilator-induced lung injury (VILI).
What strategy is this for?
VENTILATORY STRATEGY FOR ARDS
VENTILATORY STRATEGY FOR ARDS
Approach:
- Low Tidal Volume Ventilation
- PEEP Optimization
- Prone Positioning
- Fi02/PEEP titration
- Consider ECMO
VENTILATORY STRATEGY FOR ARDS
Approach:
- (LTVV):________ml/kg ideal body weight
to prevent overdistension. - _______ cmH20 normal PEEP used in ARDS.
To prevent alveolar collapse. - This positioning is recommend for ARDS. It improves oxygenation by redistributing lung perfusion?
- Adjust Fi02/PEEP to maintain
Pa02 of _____mmHg or Sp02 of _____% - ECMO meaning? Use of ecmo?
- 4-6ml/kg
- 5-15 cmH20
- Prone Positioning
- Pa02 of >55mmHg or Sa02 of >88%
- ExtraCorporeal Membrane Oxygenation.
It is used in severe cases of hypoxemia
Restore oxygenation and reduce patient work of breathing.
What ventilatory strategy is this for?
VENTILATORY STRATEGY FOR PNEUMONIA
VENTILATORY STRATEGY FOR PNEUMONIA
Approach:
- Non-Invasive Positive Pressure Ventilation (NIPPV)
- PEEP
- Higher Fi02
- Monitor hypercapnia
VENTILATORY STRATEGY FOR PNEUMONIA
Approach
- Use _____ or _____ if px is hemodynamically stable.
- PEEP for pneumonia (________cmH20) to prevent alveolar collapse.
- Ensure Pa02 of ______mmHg or Sp02 of _____%.
- If hypercapnia is severe you need to switch to?
- CPAP or BiPAP
- 5-10 cmH20
- Pa02 of > 60 mmHg or Sp02 of 92%
- Invasive ventilation
Improve oxygenation, manage ventilation, and reduce the workload on the heart.
What ventilatory strategy is this for?
VENTILATORY STRATEGY FOR
PULMONARY EMBOLISM
VENTILATORY STRATEGY FOR
PULMONARY EMBOLISM
Approach:
- Low Tidal Volume
- Set Moderate PEEP
VENTILATORY STRATEGY FOR
PULMONARY EMBOLISM
Approach
- PEEP for Pulmonary Embolism
( ________cmH20)
- What to avoid using in pulmonary embolism?
- What is compromised if you don’t avoid it?
- 5-10 cmH20
- Avoid using increased PEEP in pulmo embolism
- Hemodynamic status
Improve oxygenation and reduce work of breathing.
What ventilatory strategy is this for?
VENTILATORY STRATEGY FOR
PULMONARY EDEMA
VENTILATORY STRATEGY FOR
PULMONARY EDEMA
Approach:
- CPAP or BiPAP
- PEEP
- Fluid Management
- Diuretics and Vasodilators
VENTILATORY STRATEGY FOR
PULMONARY EDEMA
Approach
- It relieves dyspnea and reduce intubation
- It helps recruit alveoli and
redistributes fluid in lungs? - Key to preventing worsening edema?
- Expell the excess fluid in the form of urine
- CPAP or BiPAP
- PEEP
- Fluid Management
- Diuretics
This type of RF results from inadequate alveolar ventilation, leading
to CO₂ retention.
Type 2 RF
Causes of Type 2 RF
- COPD
- Asthma
- Neuromuscular Disease
Correct hypercapnia and relieve respiratory distress without over-distending lungs.
What ventilatory strategy is this for?
VENTILATORY STRATEGY FOR COPD
VENTILATORY STRATEGY FOR COPD
Approach:
- Non-Invasive Ventilation (NIV)
- Low Tidal Volume
- PEEP
- Fi02
VENTILATORY STRATEGY FOR COPD
Approach
- What is the preferred mode & why?
- Low Vt To avoid ________.
- Applied carefully and typically at lower levels to prevent exacerbation of auto-PEEP.
- Start low, titrate based on SpO₂ or PaO₂ to avoid hyperoxia-induced hypercapnia.
- BiPAP, it has 2 pressure supports (Inspiratory & Expiratory)
- Auto-PEEP or Airtrapping
- PEEP
- Fi02
Minimize barotrauma and avoid dynamic hyperinflation.
What ventilatory strategies are this for?
- VENTILATORY STRATEGY FOR ASTHMA
- VENTILATORY STRATEGY FOR NMD
VENTILATORY STRATEGY FOR ASTHMA
Approach:
1. To prevent high airway pressures. (^levels of PaC02)
2. Allows prolonged expiration.
3. Limit to prevent lung injury.
4. Can worsen air trapping in severe cases.
- Permissive Hypercapnia
- Low Respiratory Rate
- Monitor PIP
- Avoid High PEEP
VENTILATORY STRATEGY FOR NMD
Approach:
- CPAP or BiPAP to support weakened muscles.
- If patient cannot maintain spontaneous breaths.
- It is adjusted based on individual’s lung compliance and avoid over-distension.
- For secretion clearance in patients with weak
Cough
- NIV for Early Intervention
- Invasive Ventilation for Severe Cases
- Tidal Volume
- Use for Cough Assist
